NDAA Conference Committee Proposes Military Health Reforms That Highlight US Family Health Plan’s Model of Care.
Starting Dec 1 TRICARE® will no longer cover prescriptions filled at CVS for some beneficiaries.
This change does not effect
- US Family Health Plan TRICARE Prime® members.
- US Family Health members can continue to use CVS to fill prescriptions.
Visit http://usfhp.net/your-plan/pharmacy-benefits/ to get information on our participating pharmacies in your area.
Department of Defense announces new Pharmacy Fees for FY 2016
The TRICARE pharmacy copays are going up as outlined in the National Defense Authorization Act for FY 2016. Here are the new copays starting February 1, 2016:
Retail 30-day Supply
• Generic: $10
• Brand Name: $24
• Non-formulary: $50
Home Delivery 90-day Supply
• Generic: $0
• Brand Name: $20
• Non-formulary: $49
TRICARE Benefit Expands to Cover New Hip Surgery
The 2015 National Defense Authorization Act created a provisional coverage program that allows TRICARE to provide coverage for emerging treatments and technologies. The first treatment to be evaluated and approved under this new program is surgical treatment of a hip condition called Femoroacetabular Impingement (FAI). FAI can occur when the bones of the hip are abnormally shaped. Because they do not fit together perfectly, the hip bones rub against each other and cause damage to the joint. Symptoms include pain in the hip or groin area which limits or hinders mobility.
Provisional coverage for FAI surgery begins January 01, 2016. At that time, your health care provider can give you a referral for treatment if you are diagnosed with this condition and meet certain clinical criteria. You will be able to get FAI surgery from any US Family Health Plan authorized orthopedic surgeon who performs this procedure. The surgery must be pre-authorized by US Family Health Plan.
Pre-authorization lets your provider present additional information so USFHP can make an individual review of your care. There is no retroactive preauthorization or coverage prior to January 01, 2016.
The American Orthopaedic Society for Sports Medicine reports that some people may have FAI their entire lives, and never have any problems. However, if symptoms develop, it usually means there is damage to the cartilage and the condition is likely to get worse.
Enrollment Premiums Increase
US Family Health Plan has been notified by the Department of Defense (DoD) that enrollment premiums will increase effective October 1, 2015 as follows:
The Defense Health Agency (DHA) calculated the FY 2016 enrollment fee amounts based on current law.
Please note: If you are currently paying your premium through your Military Retirement, or using our automatic recurring plan for Electronic Funds Transfer (EFT) or Credit Card, no action is required. Your premium will continue to be deducted automatically.
Letter Sent in Error to US Family Health Plan Members
Updated September 4th, 2015
If you are a current US Family Health Plan member, you might receive a letter from TRICARE regarding obtaining prescriptions by mail through Express Scripts.
Please be aware that that letter was sent by TRICARE to US Family Health Plan members in error, and you should disregard it.
US Family Health Plan provides the Home Delivery pharmacy benefit to our members, and will continue to do so.
If you have questions, please call Member Services at 1-800-241-4848. For information on Maxor Home Delivery, visit usfhp.net/your-plan/pharmacy-benefits/.
Breast Pump Benefit
TRICARE policy was recently updated to include coverage for breast pumps. Manual and standard electric breast pumps are covered. Associated supplies, breast pump kits and breastfeeding counseling are included. This coverage is for all pregnant TRICARE beneficiaries. The policy also applies to beneficiaries who legally adopt and intend to personally breastfeed.
To get a breast pump and related supplies follow these steps:
- Get a referral and prescription from your provider.
- Call the US Family Health Plan Durable Medical Equipment vendor:
Mount Holly Surgical Supplies @ 1-888-767-0221.
If you pay out of pocket for a covered breast pump please submit a receipt for reimbursement. Call Customer Service at 800-241-4848 for assistance if needed.